<div id="modal-container-996233" class="modal hide fade" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true">
    <div class="modal-header">
        <button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
        <h3 id="myModalLabel">
            Cadastrar Filial
        </h3>
    </div>
    <div class="modal-body">
        <div class="alert alert-error alert-error-modal" style="display:none"> 
            <button type="button" class="close" data-dismiss="alert">&times;</button>
            <span></span>
        </div>

        <div class="alert alert-success alert-error-modal-success" style="display:none"> 
            <button type="button" class="close" data-dismiss="alert">&times;</button>
            <span></span>
        </div>

        <form action="<?php echo $this->baseUrl() ?>/filial/criar" method="post" class="form-horizontal forms" role="form">
            <div class="form-group">
                <div class="col-sm-10">
                    <div class="input-prepend input-append">
                        <span class="add-on"><i class="icon-home"></i></span> 
                        <input type="text" class="form-control" name="nome" placeholder="Nome da Filial" maxlength="80" title="Filial" required>
                    </div>
                </div>
            </div>
            
            <div class="form-group">
                <div class="col-sm-10">
                    <div class="input-prepend input-append">
                        <span class="add-on"><i class="icon-map-marker"></i></span> 
                        <input type="text" class="form-control" name="cidade" placeholder="Nome da Cidade" maxlength="80" title="Cidade" required>
                    </div>
                </div>
            </div>            

            <div class="form-group">
                <div class="col-sm-offset-2 col-sm-10 btns-form">
                    <button type="submit" class="btn btn-large btn-primary">Salvar</button>
                    <button type="reset" class="btn btn-large btn-default">Limpar</button>
                </div>
            </div>
        </form>
    </div>
    <div class="modal-footer">
        <button class="btn" data-dismiss="modal" aria-hidden="true">Fechar</button>
    </div>
</div>